Published in Pain Medicine, volume 20, Issue 11, November 2019
First published in 2018
THIS is the study that is often referred to as ‘evidence’ that tapering opioids does NOT result in increased pain. According to google scholar, it has been cited 35 times, most of which it was used as evidence that tapering opioids does not increase pain.
Every person who lives with severe, daily pain knows that this is not true. While some people can taper off opioids and not experience increased pain, those people are the minority. For most people living with severe chronic pain, tapering opioids DOES result in increased pain, increased disability, and reduced functionality and reduced quality of life.
Yet his study DID find that tapering opioids results in either improved pain, or the pain remains the same, despite the lower dose.
However, it is to be noted that this information was generated from type 3 and 4 studies, which is considered to be very low quality evidence. The study states that because of this low quality evidence:
the conclusion states
The results of this systematic review support the clinical observation that opioid tapering in some CPPs does not necessarily increase pain. However, as the reviewed studies were type 3 and 4 (low level of evidence) and the focus of this review was not their primary question, further research is required to answer this question in a definitive manner. These studies should be prospective, type 2 studies specifically designed to address the hypothesis of this systematic review
Hardly a ringing endorsement. Very low-quality evidence should never be used to inform treatment guidelines or guide policy, and it’s shocking how often this study has been cited to ‘prove’ that tapering does not result in increased pain.
Additionally, none of these studies set out to examine if tapering resulted in increased pain, the data was extrapolated from studies looking at other outcomes.
What this study shows is that policy makers are very happy to ignore high-quality evidence, in favour of low-quality evidence, when it suits their agenda.
Bottom line? This study does NOT evidence that opioids tapers do not lead to increased pain. The only thing that this study conclusively demonstrates is that everyone who cited it as evidence didn’t bother to read it!
More studies on opioid tapering.